Get Social Security Disability & SSI Benefits: Spinal Stenosis

Winning Your Spinal Stenosis Case

Video

Disability With Spinal Stenosis

Reporting Your Symptoms

Establishing Your Limitations

Proving That You Are Disabled

Your Spinal Stenosis Medical And How Social Security Reviews It

Social Security regularly makes disability decisions regarding spinal stenosis which is a narrowing of the spinal canal that causes pressure on the spinal cord and nerve roots. Spinal stenosis is most common in the lumbar and cervical spine - less so in the thoracic spine. It is most commonly caused by a variety of impairments -

1. Bulging, herniated, ruptured, or slipped disc;
2. Degenerative disk disease (arthritis of the spinal vertebrae);
3. Spondylolisthesis (one vertebra slips in front or behind the other);
4. Excessive scar tissue; and
5. Spinal arachnoiditis.

For a disability case, Social Security will require you have medical tests proving your spinal stenosis which is an MRI or CT (an MRI is better if you can get one done), and EMG testing if there is either upper or lower extremity involvement (neuropathy or radiculopathy). X-rays are not precise enough to determine the severity of spinal stenosis. On MRI or CT, Social Security generally regards "marked," "severe," or "extreme" spinal stenosis as consistent with disability. "Moderate" spinal stenosis is generally not consistent with disability. Social Security will very, very rarely find you have a disabling spinal stenosis impairment if the findings are "mild."

In addition to diagnostic medical tests, Social Security will need to review your medical treatment records. There are a number of important issues regarding treatment. First, the more treatment you receive, and the more significant that treatment is, the more likely Social Security will find you meet its disability criteria. Second, treatment usually includes attempts to manage pain - pain medications; muscle relaxers; steriod injections; TENS unit; or in severe cases, a spinal cord stimulator. Treatment may also include chiropractic care, massage, acupuncture, injections, or physical or occupational therapy. Third, your medical treatment records will include clinical evaluations of you by your doctor. These evaluations will include your doctor's opinion about your symptoms and the severity of your symptoms, and your doctor's findings made in his clinical examination of you.

After Social Security opens your medical file, it will expect to see the following symptoms:

1. Pain,
2. Numbness and tingling,
3. Muscle spasms,
4. Weakness,
5. Muscle atrophy, and
6. Sometimes extremity neuropathy.

If you have surgery, you will need to submit that evidence to Social Security as well - Back & Neck Surgeries And How They Affect Your SSDI/SSI Social Security Disability Case. Any surgery indicates your spinal stenosis is more severe than if you do not have surgery. Post-surgery results are also important in any disability case.

The Social Security & SSI Spinal Stenosis Listing

You will satisfy Step 3, if you meet or equal Adult Listing 1.04A. You are required to establish nerve root compression and one of the following:

1. Pain, reduced range of spine motion, atrophy/muscle weakness, loss of sensory or reflex, and positive lumbar (if spinal stenosis affects the lumbar spine) straight leg raising;
2. Arachnoiditis (scar tissue causing clumping of spinal nerves) with pain and the need for position changes; or
3. Lumbar stenosis with pseudoclaudication, pain, muscle weakness, and an inability to walk efficiently.

Helpful Resource

1. Lumbar Spine Stenosis Video - Spine-health

A Spinal Stenosis Success Story - The Power Of An Independent Physician Statement

Mr. Garrity lived in San Diego, CA. He was diagnosed with spinal stenosis of the lumbar spine, nerve root impingement, and obesity (his BMI was rather high at 40). Despite his nerve root impingement, he did not suffer lower extremity neuropathy. However, he did have significant low back and hip pain, weakness, and reduced range of motion. He spent most of his day reclining or lying down. He used a cane. He was 42 years old.

Mr. Garrity hired counsel just prior to the Social Security disability hearing. He had applied for Social Security disability and SSI benefits. Counsel had to hurry to get ready for his hearing. Counsel had him fill out a fee agreement and Appointment of Representative form (1696) and submitted both forms to the hearing office. About two days later, counsel was able to get electronic access to his on-line Social Security file on Social Security's server. Regular practice at the hearing offices is that the hearing office does not regularly update medical records (this responsibility falls on the claimant). Ms. Garrity's case was no exception. Counsel had to update his medical records from his primary treating doctor, and his orthopedist. Counsel also had to order new records from an orthopedic surgeon Mr. Garrity visited, and physical therapy records. As is common, the surgeon denied surgery because of Mr. Garrity's weight. Counsel obtained a statement from both Mr. Garrity's mother and sister about his physical limitations. I asked Mr. Garrity to take pictures of his home as he installed a shower chair, a shower bar, a raised toilet seat, and a small make-shift ramp on his back steps.

There was a stand-out issue in Mr. Garrity's case. The doctor who reviewed his case for Social Security wrote that Mr. Garrity's back condition was not disabling, in part, he opined, because the surgeon declined to perform a surgery. Mr. Garrity also underwent a consultative examination (CE) with another Social Security doctor who parrotted the opinion of the doctor who previously reviewed the case. Counsel felt it was necessary to obtain an opinion about Mr. Garrity's back condition from an independent doctor. However, the treating primary doctor, nor the orthopedist, nor the surgeon would speak to counsel. Counsel contacted a retired orthopedic surgeon to review Mr. Garrity's file and render an opinion about his case. This doctor 1) reviewed about 50 pages of Mr. Garrity's medical records, 2) reviewed Social Security listing 1.05, 3) and wrote a four-page report summarizing Ms. Garrity's medical conditions and residual functional capacity (RFC) which is an assessment of what he was able to do physically. The doctor found Mr. Garrity could sit, stand, and walk for only a total of six hours a day. This RFC meant Mr. Garrity could not work eight hours a day and that he was disabled.

At the hearing, Mr. Garrity explained himself well. The theory of disability was in the alternative, 1) he met listing 1.05, and 2) his RFC was less-than-sedentary. Therefore, counsel focused his testimony on the listing criteria and his functional limitations. Counsel also focused on his obesity as this was a primary reason he could not obtain a surgery that may cure his back condition and allow him to return to work. Although counsel prepared Mr. Garrity's friend to testify at his hearing, there was no time for a witness at his hearing. The hearing administrative law judge (ALJ) disallowed his testimony but did allow a post-hearing written statement. Counsel asked Mr. Garrity's friend to write a statement about Mr. Garrity's limitations that he observed. After a three month wait, Mr. Garrity received a fully favorable decision awarded both SSDI and SSI benefits.

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